198602274-9-10-2026-11-AS-SCIS-DXTVZW-20260911165321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602274
Report Date: 09/10/2026
Date Signed: 09/10/2026 10:09:28 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2026 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260615094658

FACILITY NAME:	SANTA FE HOME CARE IV		FACILITY NUMBER:	198602274
ADMINISTRATOR:	GRADNEY, ANGELIQUE		FACILITY TYPE:	740
ADDRESS:	5010 TORRANCE BLVD		TELEPHONE:	(310) 316-0001
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 6	DATE:	09/10/2026
		UNANNOUNCED	TIME BEGAN:	08:18 AM
MET WITH:	House Manager - Nelson Ortega,		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Unqualified staff are administering insulin.
Staff does not ensure residents privacy is protected.
Staff interacts inappropriately with resident.

INVESTIGATION FINDINGS:

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*This report does not supersede the complaint investigation conducted on 06/25/2026 but is used to clarify findings. *

On 09/10/26 Licensing Program Analyst (LPA) Troy Watson conducted a subsequent complaint visit to the facility listed above. LPA Watson was greeted by the Care Giver Resti Saragih and the purpose of the visit was explained. The LPA was granted entry into the facility.

Investigation consisted of the following:
On 06/25/2026 the department requested and obtained the following documentation: Personnel Roster, Resident Roster. On 07/21/2026 the department requested and obtained the following documentation, Medical Administration Record for R1 dated 12/05/25 – 01/19/26,

CONTINUED ON LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20260615094658

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE IV	FACILITY NUMBER: 198602274
	VISIT DATE: 09/10/2026

NARRATIVE

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Initial Staff Training Requirements dated 10/28/24 – 11-25-24. The department interviewed Residents #4 and #6 (R1 and R6) and Staff#1–3# (S1-S3). An attempt was made to interview R1; however, R1 was no longer residing at the facility at the time the interviews were conducted. Attempts were also made to interview R2, R3, and R5, but all three residents are non-verbal and unable to respond to interview questions.

Allegation: Staff does not ensure residents’ privacy is protected.

It is alleged that staff did not protect residents’ privacy and posted photos and videos of residents on social media.

On 06/25/2026 the department conducted an interview with Licensee Angelique Gradney Staff#1 (S1). During the interview, S1 was asked if staff ensured residents privacy is protected. S1 stated that staff ensure residents’ privacy is protected. Regarding the facility’s policy on photos or videos, S1 explained that staff do not take any images of residents; only a third party may take pictures when needed for medical assessments.
An attempt was made to interview R1; however, R1 was no longer residing at the facility at the time the interviews were conducted. Attempts were also made to interview R2, R3, and R5, but all three residents are non-verbal and unable to respond to interview questions.

On 06/25/2026 between 09:15AM – 02:30 PM the department interviewed Residents #4 and #6 (R1 and R6). Out of those Residents interviewed (2) out of (2) denied the above allegation. On 06/25/2026 the department interviewed Staff#1– #3 (S1-S3). Out of those staff interviewed (3) out of (3) denied the above allegation. On 06/25/2026 the department reviewed the facility staff’s social media page, and it showed pictures of residents posted without their permission. The department requested but could not obtain any documentation, or consent form signed by the residents, their power of attorney or conservator authorizing the use of their image or likeness. The posting of resident’s pictures without their consent is a violation of the residents’ personal rights.

Based on interviews and record reviews, the preponderance of evidence has been met; therefore, the allegation is Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D
An exit interview was conducted with the House Manager Nelson Ortega, and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20260615094658

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SANTA FE HOME CARE IV	FACILITY NUMBER: 198602274
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/10/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/17/2026 Section Cited CCR 87468.1(a)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities 87468.1(a), Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.	1 2 3 4 5 6 7	Licensee shall provide all staff with training on personal rights of residence pertaining to the residents privacy. Licensee will provide copies of training materials and sign in sheet to the department by POC due date 09/17/26, via email to troy.watson@dss.ca.gov.
	8 9 10 11 12 13 14	Based on observation interviews, and social media observations, Staff posted pictures of R1 on social media without consent. This violation poses a personal rights and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026

LIC9099 (FAS) - (06/04)

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